Kudos to the grant writers at Vermont’s Dept. of Health Access for obtaining $156 million from the federal government to assist with the implementation of the health exchange, the new insurance marketplace scheduled to go online in October, 2013 as part of Obamacare (“Vt. ranks third in federal health exchange money, Times Argus Jan 5, 2013). The $156 million will lead to the creation of a large number of high quality jobs. Obtaining outside money for Vermont helps the economy and adds to our tax base.

Of course, this might have been better news if this money were designated for something other than unnecessary administrative activity in the US health care system. Had President Obama and the US Congress had more courage, they would have voted to simply extend Medicare to the entire US population. Such a proposal would have obviated the need for exchanges. For that matter, extending Medicare to every American would have eliminated the need for the entire private insurance industry, which contributes only excessive cost and human misery to the US health care system.

While the $156 million coming to Vermont is certainly a waste of federal taxpayer money, this waste pales in comparison to the billions of dollars that will be diverted to private insurers by the Obamacare legislation.

With the new health exchange the $156 million creates, Vermonters will be able to search for very expensive private policies providing coverage that would be disdained by citizens of every other developed country. The exchange will also feature policies with slightly less ridiculously expensive premiums. But these policies will have even worse coverage — even higher deductibles and co-pays. No bargains in Obamacare.

What’s really sad is that at the federal level, there is no way to vote for single payer health care. The Democrats are largely lined up behind Obamacare. And the proposals coming from the Republicans both in Vermont and nationally have at least as much administrative expense and provide vastly less secure coverage compared to Obamacare. The few Republican proposals that actually extend coverage to additional Americans provide the type of coverage that’s really there for you — as long as you don’t get sick.

There never has been a good reason why Americans pay into Medicare throughout their entire lives, but aren’t covered by the program until they turn 65, Single payer health care — such as the Medicare program — saves lives and money. We shouldn’t rest until the entire US population can enjoy its benefits. State-based, single payer reform, as we’re attempting here in Vermont may be the only viable strategy to eventually expand Medicare to every citizen of our country.

Dr. Marvin Malek is an internist working at Central Vermont Hospital in Berlin.